Greenville Memorial working to resolve Medicare, Medicaid issue

Greenville Memorial Hospital
Greenville Memorial Hospital

GREENVILLE, SC (WSPA) – A notice published in a local newspaper is causing some concern after it said that Medicare will no longer be accepted at Greenville Memorial Hospital in April.

Now the hospital says it will affect Medicaid too.

Based on Greenville Memorial Hospital’s Financial Year 2016 volume, roughly 21,000 Medicare and Medicaid inpatients could potentially be affected, according to Sandy Dees with Greenville Hospital Systems.

Dees says this represents about 59% of Memorial’s inpatients.

The net revenue at risk from Medicare and Medicaid patients (both inpatient and outpatient net revenue for patients at Greenville Memorial) could potentially be approximately $495 million, according to Dees.

Dees says they do not anticipate any interruption.

The public notice published in the Greenville News says that the agreement between Greenville Health System’s Greenville Memorial Hospital Medicaid and Medicare will be terminated as of April 16.

According to GHS, the hospital is making changes to improve its emergency department after the Center for Medicare and Medicaid Services (CMS) found the hospital was not in compliance

Scott M. Sasser, chair of emergency medicine at GHS, says they do not “anticipate any interruption of Medicare services.”

GHS says they called for the emergency room audit because they felt there were ways they could improve.

According to the CMS, the emergency room survey was triggered by the death of Donald Smith in early March.

April Washington of CMS says the hospital, “administered an injection without the clinical assessment of patient’s condition to ensure the patients safety while being restrained.”

CMS also says that the hospital has a right to submit a plan telling them how they are taking steps to correct the deficiencies prior to termination. Those steps would be reviewed and another site visit would be likely to make sure the hospital is taking the appropriate steps.

They say there is no immediate threat of patients having to be moved or transferred from the hospital.

The ad reads:

Medicaid notice

PUBLIC NOTICE FOR INVOLUNTARY TERMINATION OF MEDICARE / MEDICAID PROVIDER AGREEMENT

Notice is hereby given that effective April 16, 2017, the agreement between GHS Greenville Memorial Hospital, 701 Grove Road, Greenville, SC 29605 and the Secretary or Health and Human Services, as a provider of Hospital Services in the Health Insurance for the Aged and Disabled Program (Medicare) is to be terminated. GHS Greenville Memorial Hospital does not meet the following conditions of participation:

42 CFR 482.12 Governing Body

42 CFR 482.13 Patient’s Rights

42 CFR 482.23 Nursing Services

The Center of Medicare and Medicaid Services has determined that GHS Greenville Memorial Hospital is not in compliance with the conditions of coverage. The Medicare program will not make payment for hospital services to patients who are admitted after April 16, 2017.

Linda Smith
Acting Associate Regional
Administrator
Division of Survey and Certification

GHS spokesperson Sandy Dees released the following statement:

Greenville Memorial Hospital (GMH) is making changes to improve processes in its emergency department following a site survey by the Centers for Medicare and Medicaid Services (CMS), which found that GMH was not in compliance with some CMS requirements.
The survey came after GMH notified CMS that the hospital had identified potential areas for improvement in the emergency department.
“Nearly all action plan items have already been initiated, and we feel confident that CMS will find our plan – and its implementation – satisfactory,” said Scott M. Sasser, MD, GHS’ chair of emergency medicine. “We do not anticipate any interruption of Medicare services, and we are committed to making improvements over and beyond what CMS requires. We’re proud of our public mission and the care we provide our community. GHS is absolutely committed to continuing to deliver high-quality care to every patient.”
The broad areas of concern cited by CMS under its conditions of participation include nursing services, patient rights and the governing body. The GMH action plan for the emergency department includes strengthening clinical documentation processes around patient care, increasing staffing and providing more intensive training.
“We take these issues very seriously and respect CMS’ judgment,” said Sasser. “Whether we have internal processes for improvement or have an opportunity presented to us by regulatory agencies, we welcome any opportunity to be better.”

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